Part One in a four-part series on the benefits of cognitive therapy for people who experience psychosis.
Forty years ago, there were two basic treatments for schizophrenia: medication and long-term hospitalization. Traditional psychotherapy was not usually offered because it did not help people with the most obvious and disturbing symptoms of psychosis: paranoia, delusions, and hallucinations. Today, there are additional treatment options that address other effects of the illness such as poor self-care, social isolation, and decreased problem-solving ability. One treatment worth considering is cognitive therapy.
Cognitive therapy is based on the idea that our thoughts influence our emotions and behaviors and that many problems in life are the result of dysfunctional thinking. An example of this is a student who gets a bad grade on a quiz because she misunderstood an important question. She might think, “I’m so stupid. I won’t ever learn this subject.” That might lead to feelings of sadness (emotion) and a decision to drop the class (behavior).
Cognitive therapy would challenge her automatic negative thinking by getting her to look at all the data: Do stupid people get accepted into college and pass all their other courses? Does one bad quiz result mean an F for the semester?
3 Important Features of Cognitive Therapy
- Cognitive therapy focuses on the present, not the past. If a person is looking to understand how childhood relationships with parents may have shaped his or her personality, cognitive therapy won’t be of much help. But if someone is stuck on a problem in the present, such as conflicts in the workplace, a cognitive approach offers ways to get unstuck.
- Cognitive therapy is results-oriented. It focuses on solving specific problems (e.g., improving working memory for better performance on a job, or overcoming a fear of crowded spaces). For that reason, it is usually time-limited with a clearly defined beginning, middle, and end.
- Cognitive therapy involves learning of skills. In cognitive therapy, people learn actual skills that can help them identify, understand, and change their thoughts, feelings, and behavior. Although trust and rapport are important, the therapeutic relationship is more about teaching and learning than it is about healing.
Cognitive therapy was originally developed to help people living with depression and was quickly adopted to treat anxiety. Now there is growing evidence that it can also help people who experience psychosis, including those with schizophrenia, bipolar disorder, and schizoaffective disorder.
Cognitive therapy can take different forms. Cognitive Behavior Therapy (CBT) is often delivered in a one-to-one relationship with a psychotherapist. Cognitive Remediation (CR) uses individualized drills and group bridging sessions to improve functioning in targeted areas of cognition such as attention, memory, and problem solving. In my own family and in the many families I have worked with at Laurel House, Inc., I have seen CBT, CR, and other cognitive approaches help people recover from some of the worst effects of their disorders. Two real world examples are:
A teen whose obsessive thoughts about demons interfere with her ability to attend classes and concentrate in school. CBT combined with medication can help her gain insight that the voices she hears are not real, providing her with self-management skills and a sense of security to return to school.
A young adult who worries about losing his delivery job because he can’t remember the driving route. CR exercises in spatial relations and problem solving, along with on-site coaching from a supported employment specialist, can provide him with thinking skills and confidence to do his job.
In both examples, cognitive therapy is provided with other forms of treatment or support. That’s because it works best when combined with other evidence-based practices such as psychopharmacology and supported employment.
2 Things You Can Do to Help Loved Ones with Schizophrenia (or any other mental illness)
- Tell them about cognitive therapy. CBT and CR are evidence-based practices that have been proven to make a positive difference in the lives of people who experience psychosis. Unlike many mental health treatments, CBT and CR are time-limited, with a focus on solving specific problems. They may also be seen as less stigmatizing because all people can benefit from healthy cognition, not just those with mental illness.
- Encourage them to do things that require the use of multiple thinking skills. When it comes to healthy cognition, neuroscientists encourage us to “use it or lose it.” Learning a language or musical instrument, taking up a new hobby, doing crossword puzzles and Sudoku, or simply interacting with other people in social situations can all have a positive impact on cognition and benefit mental health.
This introduction to cognitive therapy is the first post in a four-part blog series. Check out Part 2 for more information on the kinds of mental health problems that cognitive therapy can help resolve.
If you think you or someone you know might benefit from cognitive therapy, it is important to seek help from a qualified mental health professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.
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